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Various pathophysiological mechanisms account for GERD, including impaired esophageal peristalsis and anatomical or physiological defects at the esophagogastric junction (EGJ). Endoscopy identifies GERD complications and detects potential alternative diagnoses. However, if symptoms persist despite proton pump inhibitor therapy, functional esophageal tests are useful to characterize reflux burden and define the symptom association profile. Ambulatory pH or pH\u2010impedance monitoring measures the 24\u2010h acid exposure time, which remains the most reproducible reflux metric and predicts response to antireflux therapy. Apart from identifying peristaltic dysfunction, esophageal high\u2010resolution manometry defines the morphology and contractile vigor (EGJ\u2010CI) of the EGJ. Novel metrics obtained from pH\u2010impedance monitoring include the postreflux swallow\u2013induced peristaltic wave index and mean nocturnal baseline impedance, which augment the diagnostic value of pH\u2010impedance testing. Mucosal impedance can also be recorded using a probe inserted through a gastroscope, or a novel balloon catheter with arrays of impedance electrodes inserted following sedated endoscopy. The latest developments in functional esophageal tests define the GERD phenotype based on pathogenesis, reflux exposure, structural or motility disorders, and symptom burden, facilitating appropriate treatment.<\/jats:p>","DOI":"10.1111\/nyas.14369","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T21:32:13Z","timestamp":1589923933000},"page":"154-169","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diagnosis of gastroesophageal reflux: an update on current and emerging modalities"],"prefix":"10.1111","volume":"1481","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4226-7902","authenticated-orcid":false,"given":"Daphne","family":"Ang","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Changi General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong\u2010Yeh","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Internal Medicine, School of Medical Sciences Universiti Sains Malaysia  Kota Bharu Malaysia"},{"name":"Gut Research Group, Faculty of Medicine National University of Malaysia  Kuala Lumpur Malaysia"},{"name":"St George and Sutherland Clinical School University of New South Wales  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John O.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristle","family":"Lynch","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Guillaume","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stony Brook Medicine Stony Brook University Hospital  Stony Brook New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Onyimba","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Maryland School of Medicine  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afrin","family":"Kamal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University  Stanford California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C. 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